Individual
ROMAN YUSUPOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1131 N 35TH AVE FL 2, HOLLYWOOD, FL 33021-5403
(954) 265-6319
(954) 276-0166
Mailing address
2900 CORPORATE WAY, DOOR D, MIRAMAR, FL 33025-3925
(954) 276-5685
(954) 985-7074
Taxonomy
Speciality
Code
Description
License number
State
207SG0201X
Clinical Genetics (M.D.) Physician
Primary
ME 107047
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017236900
—
FL
Enumeration date
07/20/2007
Last updated
03/16/2021
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